Implementing the SAFE@home digital platform for blood pressure home monitoring for patients with (a risk of) hypertensive disorders of pregnancy: A barrier and facilitator analysis among obstetric healthcare professionals.

Introduction: Hypertensive disorders of pregnancy complicate at least 10% of pregnancies, and are associated with fetomaternal morbidity and mortality. Traditional management is resource-intensive. Remote monitoring offers a safe and patient friendly alternative to managing hypertensive disorders. However, scaling telemonitoring requires understanding of implementation facilitators and barriers. This study explores the implementation of SAFE@home, a platform for monitoring blood pressure and symptoms, among obstetric healthcare professionals (OHPs). Material and methods: An implementation study was conducted across 11 Dutch hospitals from November 2020 to December 2023, evaluating implementation of a home-monitoring platform for pregnant women with a high risk of or with established hypertensive disorders. Implementation outcomes were evaluated using Proctor's taxonomy, Normalization Measurement Development and Measurement Instrument for Determinants of Innovations questionnaires, platform, and electronic health records data. OHPs received questionnaires at the start of implementation (T = 1) and between 9 and 18 months (T = 2). Median and proportion of scores were analyzed. Results: Of 133 OHPs, 83 (62.4%) and 101 (75.9%) responded to T = 1 and T = 2, respectively. SAFE@home was well-received, with a median score of 4/5 on questionnaires at both time points. Adoption was 100%, and OHPs were receptive to using the platform (95% at T = 1; 92% at T = 2). Confidence in using SAFE@home was 48% (T = 1) and 85% (T = 2); 86% believed it improved outcomes and 82% found work integration easy. Overall, 91% anticipated SAFE@home to become routine. Barriers included time constraints (46%) and uncertainty about usage (20%). Conclusions: SAFE@home was successfully implemented, with high acceptance and sustainability potential. While time constraints and initial uncertainty were barriers, most OHPs believed telemonitoring could improve care for high-risk pregnancies.